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Pancreatic Cancer: Diagnostic & Maintenance Tools

Pancreatic Cancer: Diagnostic & Maintenance Tools. Felice Schnoll-Sussman, MD Jay Monahan Center for Gastrointestinal Health New York Hospital/ Weill Cornell Medical College. Normal Hepatobiliary Anatomy. An abnormality of the hepatobiliary system is suspected. WHAT IS THE NEXT STEP???.

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Pancreatic Cancer: Diagnostic & Maintenance Tools

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  1. Pancreatic Cancer: Diagnostic & Maintenance Tools Felice Schnoll-Sussman, MD Jay Monahan Center for Gastrointestinal Health New York Hospital/ Weill Cornell Medical College

  2. Normal Hepatobiliary Anatomy

  3. An abnormality of the hepatobiliary system is suspected... WHAT IS THE NEXT STEP???

  4. ULTRASOUND CT SCAN MRCP ??? MRI EUS CA19-9

  5. Ultrasound • Least invasive radiologic technique • Portable, quick and can guide interventional procedures • No ionizing radiation • High sensitivity for detected dilated bile ducts and biliary tract obstruction (obstructive jaundice) • Very sensitive for differentiating cystic from solid lesions • Overlying gas may obscure visualization

  6. Ultrasound (Sonogram)Patient Preparation • Clear liquid diet for 24 hours prior to exam • Liquids include clear juices such as apple, cranberry & grape, clear soups, jello, coffee or tea. No milk products or carbonated bevarages

  7. CT SCAN(Computed Tomography) • Primary imaging study for patients suspected of having pancreatic lesion • Thin section dual-phase spiral CT scan • Obtained during optimal pancreatic arterial and portal venous enhancement and hepatic phase

  8. CT (CAT SCAN)Patient Preparation • Clear liquid diet for 24 hours prior to exam • Patients with prior reactions to iodinated contrast or allergic history require pretreatment medication • Diabetics: Alert doctor if your are taking glucophage

  9. ERCP(Endoscopic Retrograde Cholangiopancreatography)Patient Preparation • Nothing by mouth after midnight the evening before procedure • No aspirin or nonsteroidal medications one week before procedure

  10. Pancreatic Cancer

  11. ERCP Tools Sphincterotome

  12. ERCP Tools Balloon

  13. ERCP Tools Stents

  14. ERCP Tools Wallstent

  15. Normal ERCP Cystic Duct Bile Duct GB PancreaticDuct

  16. Pancreatic Cancer stricture

  17. Balloon Dilatation of Stricture

  18. Diagnostic ERCP Double duct sign CBD Stricture Main PD stricture

  19. Stent

  20. Combined Procedure PTC ERCP

  21. Wall Street JournalOctober 28, 1981MRI has arrived ...

  22. What is MRCP?Magnetic Resonance Cholangiopancreatography • Well established tool for evaluating the biliary tree, pancreatic ducts and gallbladder • Well tolerated • Role: • To DIAGNOSE (not treat) diseases of the biliary and pancreatic ducts • To avoid invasive procedure risks • Reduce morbidity

  23. MRCP: Background • MRI of the bile ducts and pancreatic ducts • Relies on radiofrequency, pulse-induced excitation of protons within a magnetic field to generate an image • Fluid in the biliary and pancreatic ducts serves as an intrinsic contrast medium • The ductal systems appear white against the black background, providing images similar to those of ERCP

  24. MRI Patient preparation Inform doctor if you have any of the following: • Surgical vascular clips • Neurostimulators • Cochlear Implants • Breast Tissue Expander • History of claustrophobia • IVC Filter • Penile Implants • Pacemaker • Silver backed dermal patches

  25. MRI Patient Preparation • Do not wear make-up • Music is available during the examination. Most centers will allow you to bring your own tape or CD

  26. Pancreatic cancer - ERCP vs. MRCP

  27. EUS ENDOSCOPIC ULTRASOUND

  28. EUS TOOLS

  29. EUS TOOLS

  30. EUS TOOLS

  31. Doppler Vessel Identification

  32. EUS(Endoscopic Ultrasound)Patient Preparation • Nothing by mouth after midnight the evening before procedure • No aspirin or nonsteroidal medications one week before procedure

  33. Pancreatic Cancer Staging Primary Tumor (T) TX Primary Tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ T1 Tumor limited to pancreas, 2 cm or less T2 Tumor limited to pancreas, greater than 2 cm T3 Tumor extends beyond pancreas, no celiac or SMA involvement T4 Tumor involves celiac axis or SMA (unresectable primary) Regional Lymph Nodes (N) NX Regional lymph nodes cannot be assessed N0 No regional lymph nodes N1 Regional lymph node metastasis Distant Metastasis (M) MX Presence of distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis

  34. CA 19-9 • Tumor marker • Amongst markers found to have the greatest sensitivity (70%) and tumor specificity (87%) • Cutoff value of 70 U/ml • Can be elevated with biliary tract obstruction by a noncancerous lesion

  35. The diagnosis is made... Can you do anything for the pain?

  36. Therapeutic EUS Celiac Plexus Block

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